Editorial

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Open AccessEditorial

Special Issue “COVID-19: Diagnostic Imaging and Beyond”

by Chiara Giraudo

J. Clin. Med. 2020, 9(9), 2721; https://doi.org/10.3390/jcm9092721 - 24 Aug 2020

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Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-COV2) outbreak in China at the end of 2019, clinicians relied on diagnostic imaging to characterize the disease’s extension and severity [...] Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

Research

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Open AccessArticle

Acute Arterial Thrombosis of Lower Extremities in COVID-19 Patients

by Robert Glavinic, Ljiljana Marcic, Stipe Dumancic, Mirela Pavicic Ivelja, Irena Jeličić, Danijela Kalibovic Govorko and Ivana Medvedec Mikić

J. Clin. Med. 2022, 11(6), 1538; https://doi.org/10.3390/jcm11061538 - 11 Mar 2022

Cited by 3 | Viewed by 3172

Abstract

Clinical signs and symptoms of COVID-19 varied from asymptomatic forms to severe, life-threatening conditions that required treatment in intensive care units. These severe forms of illness are connected with a hypercoagulable state due to excessive inflammation, hypoxia, immobilisation, and altered angiotensin-converting enzyme 2 [...] Read more.

Clinical signs and symptoms of COVID-19 varied from asymptomatic forms to severe, life-threatening conditions that required treatment in intensive care units. These severe forms of illness are connected with a hypercoagulable state due to excessive inflammation, hypoxia, immobilisation, and altered angiotensin-converting enzyme 2 (ACE-2). In total, 17 COVID-19 positive patients were diagnosed with peripheral arterial thrombosis (AT), 13 of them had COVID-19 pneumonia. Laboratory findings in patients with X-ray confirmed pneumonia showed a four times higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and three times higher lactate dehydrogenase level (LDH) than patients without confirmed pneumonia. Patients with pneumonia had significantly more bilateral occlusions of the lower extremities and a significantly higher percentage with complete occlusion of the arteries than patients without pneumonia. The rate of limb loss was 35.3%. They were all from the group with COVID-19 pneumonia. Ten out of thirteen patients with pneumonia died due to acute respiratory distress syndrome (ARDS). All patients without pneumonia were discharged from the hospital. The aim of this retrospective study was to report the incidence of arterial thrombosis of lower extremities and their complications in the acute phase of the infection among COVID-19 patients admitted to the hospital for treatment. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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13 pages, 1129 KiB

Open AccessArticle

A Deep Learning Ensemble Approach for Automated COVID-19 Detection from Chest CT Images

by Gaetano Zazzaro, Francesco Martone, Gianpaolo Romano and Luigi Pavone

J. Clin. Med. 2021, 10(24), 5982; https://doi.org/10.3390/jcm10245982 - 20 Dec 2021

Cited by 2 | Viewed by 1534

Abstract

Background: The aim of this study was to evaluate the performance of an automated COVID-19 detection method based on a transfer learning technique that makes use of chest computed tomography (CT) images. Method: In this study, we used a publicly available multiclass CT [...] Read more.

Background: The aim of this study was to evaluate the performance of an automated COVID-19 detection method based on a transfer learning technique that makes use of chest computed tomography (CT) images. Method: In this study, we used a publicly available multiclass CT scan dataset containing 4171 CT scans of 210 different patients. In particular, we extracted features from the CT images using a set of convolutional neural networks (CNNs) that had been pretrained on the ImageNet dataset as feature extractors, and we then selected a subset of these features using the Information Gain filter. The resulting feature vectors were then used to train a set of k Nearest Neighbors classifiers with 10-fold cross validation to assess the classification performance of the features that had been extracted by each CNN. Finally, a majority voting approach was used to classify each image into two different classes: COVID-19 and NO COVID-19. Results: A total of 414 images of the test set (10% of the complete dataset) were correctly classified, and only 4 were misclassified, yielding a final classification accuracy of 99.04%. Conclusions: The high performance that was achieved by the method could make it feasible option that could be used to assist radiologists in COVID-19 diagnosis through the use of CT images. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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13 pages, 1600 KiB

Open AccessArticle

COVID-19 Pandemic and Upcoming Influenza Season—Does an Expert’s Computed Tomography Assessment Differentially Identify COVID-19, Influenza and Pneumonias of Other Origin?

by Johannes Rueckel, Nicola Fink, Sophia Kaestle, Theresa Stüber, Vincent Schwarze, Eva Gresser, Boj F. Hoppe, Jan Rudolph, Wolfgang G. Kunz, Jens Ricke and Bastian O. Sabel

J. Clin. Med. 2021, 10(1), 84; https://doi.org/10.3390/jcm10010084 - 28 Dec 2020

Cited by 3 | Viewed by 2698

Abstract

(1) Background: Time-consuming SARS-CoV-2 RT-PCR suffers from limited sensitivity in early infection stages whereas fast available chest CT can already raise COVID-19 suspicion. Nevertheless, radiologists’ performance to differentiate COVID-19, especially from influenza pneumonia, is not sufficiently characterized. (2) Methods: A total of 201 [...] Read more.

(1) Background: Time-consuming SARS-CoV-2 RT-PCR suffers from limited sensitivity in early infection stages whereas fast available chest CT can already raise COVID-19 suspicion. Nevertheless, radiologists’ performance to differentiate COVID-19, especially from influenza pneumonia, is not sufficiently characterized. (2) Methods: A total of 201 pneumonia CTs were identified and divided into subgroups based on RT-PCR: 78 COVID-19 CTs, 65 influenza CTs and 62 Non-COVID-19-Non-influenza (NCNI) CTs. Three radiology experts (blinded from RT-PCR results) raised pathogen-specific suspicion (separately for COVID-19, influenza, bacterial pneumonia and fungal pneumonia) according to the following reading scores: 0—not typical/1—possible/2—highly suspected. Diagnostic performances were calculated with RT-PCR as a reference standard. Dependencies of radiologists’ pathogen suspicion scores were characterized by Pearson’s Chi² Test for Independence. (3) Results: Depending on whether the intermediate reading score 1 was considered as positive or negative, radiologists correctly classified 83–85% (vs. NCNI)/79–82% (vs. influenza) of COVID-19 cases (sensitivity up to 94%). Contrarily, radiologists correctly classified only 52–56% (vs. NCNI)/50–60% (vs. COVID-19) of influenza cases. The COVID-19 scoring was more specific than the influenza scoring compared with suspected bacterial or fungal infection. (4) Conclusions: High-accuracy COVID-19 detection by CT might expedite patient management even during the upcoming influenza season. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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17 pages, 2455 KiB

Open AccessArticle

Effects of Prone Ventilation on Oxygenation, Inflammation, and Lung Infiltrates in COVID-19 Related Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

by Rohit Khullar, Shrey Shah, Gagandeep Singh, Joseph Bae, Rishabh Gattu, Shubham Jain, Jeremy Green, Thiruvengadam Anandarangam, Marc Cohen, Nikhil Madan and Prateek Prasanna

J. Clin. Med. 2020, 9(12), 4129; https://doi.org/10.3390/jcm9124129 - 21 Dec 2020

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Abstract

Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76–98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on [...] Read more.

Patients receiving mechanical ventilation for coronavirus disease 2019 (COVID-19) related, moderate-to-severe acute respiratory distress syndrome (CARDS) have mortality rates between 76–98%. The objective of this retrospective cohort study was to identify differences in prone ventilation effects on oxygenation, pulmonary infiltrates (as observed on chest X-ray (CXR)), and systemic inflammation in CARDS patients by survivorship and to identify baseline characteristics associated with survival after prone ventilation. The study cohort included 23 patients with moderate-to-severe CARDS who received prone ventilation for ≥16 h/day and was segmented by living status: living (n = 6) and deceased (n = 17). Immediately after prone ventilation, PaO₂/FiO₂ improved by 108% (p < 0.03) for the living and 150% (p < 3 × 10⁻⁴) for the deceased. However, the 48 h change in lung infiltrate severity in gravity-dependent lung zones was significantly better for the living than for the deceased (p < 0.02). In CXRs of the lower lungs before prone ventilation, we observed 5 patients with confluent infiltrates bilaterally, 12 patients with ground-glass opacities (GGOs) bilaterally, and 6 patients with mixed infiltrate patterns; 80% of patients with confluent infiltrates were alive vs. 8% of patients with GGOs. In conclusion, our small study indicates that CXRs may offer clinical utility in selecting patients with moderate-to-severe CARDS who will benefit from prone ventilation. Additionally, our study suggests that lung infiltrate severity may be a better indicator of patient disposition after prone ventilation than PaO₂/FiO₂. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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11 pages, 1331 KiB

Open AccessArticle

Retrospective Analysis of a Modified Organizational Model to Guarantee CT Workflow during the COVID-19 Outbreak in the Tertiary Hospital of Padova, Italy

by Giacomo Cester, Chiara Giraudo, Francesco Causin, Deris Gianni Boemo, Mariagiulia Anglani, Alfio Capizzi, Giovanni Carretta, Annamaria Cattelan, Diego Cecchin, Vito Cianci, Andrea Crisanti, Giorgio De Conti, Daniele Donato, Luciano Flor, Joseph-Domenico Gabrieli, Marina Munari, Paolo Navalesi, Alberto Ponzoni, Maria Luisa Scapellato, Ivo Tiberio, Andrea Vianello and Roberto Stramare Show full author list Hide full author list

J. Clin. Med. 2020, 9(9), 3042; https://doi.org/10.3390/jcm9093042 - 21 Sep 2020

Cited by 4 | Viewed by 2655

Abstract

At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in Italy, the cluster of Vò Euganeo was managed by the University Hospital of Padova. The Department of Diagnostic Imaging (DDI) conceived an organizational approach based on three different pathways [...] Read more.

At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) outbreak in Italy, the cluster of Vò Euganeo was managed by the University Hospital of Padova. The Department of Diagnostic Imaging (DDI) conceived an organizational approach based on three different pathways for low-risk, high-risk, and confirmed Coronavirus Disease 19 (COVID-19) patients to accomplish three main targets: guarantee a safe pathway for non-COVID-19 patients, ensure health personnel safety, and maintain an efficient workload. Thus, an additional pathway was created with the aid of a trailer-mounted Computed Tomography (CT) scanner devoted to positive patients. We evaluated the performance of our approach from February 21 through April 12 in terms of workload (e.g., number of CT examinations) and safety (COVID-19-positive healthcare workers). There was an average of 72.2 and 17.8 COVID-19 patients per day in wards and the Intensive Care Unit (ICU), respectively. A total of 176 high-risk and positive patients were examined. High Resolution Computed Tomography (HRCT) was one of the most common exams, and 24 pulmonary embolism scans were performed. No in-hospital transmission occurred in the DDI neither among patients nor among health personnel. The weekly number of in-patient CT examinations decreased by 27.4%, and the surgical procedures decreased by 29.5%. Patient screening and dedicated diagnostic pathways allowed the maintenance of high standards of care while working in safety. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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11 pages, 443 KiB

Open AccessArticle

Patients with Initial Negative RT-PCR and Typical Imaging of COVID-19: Clinical Implications

by Florent Baicry, Pierrick Le Borgne, Thibaut Fabacher, Martin Behr, Elena Laura Lemaitre, Paul-Albert Gayol, Sébastien Harscoat, Nirvan Issur, Sabrina Garnier-Kepka, Mickael Ohana, Pascal Bilbault and Mathieu Oberlin

J. Clin. Med. 2020, 9(9), 3014; https://doi.org/10.3390/jcm9093014 - 18 Sep 2020

Cited by 8 | Viewed by 3257

Abstract

The sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) has been questioned due to negative results in some patients who were strongly suspected of having coronavirus disease 2019 (COVID-19). The aim of our study was to analyze the prognosis of infected patients with [...] Read more.

The sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) has been questioned due to negative results in some patients who were strongly suspected of having coronavirus disease 2019 (COVID-19). The aim of our study was to analyze the prognosis of infected patients with initial negative RT-PCR in the emergency department (ED) during the COVID-19 outbreak. This study included two cohorts of adult inpatients admitted into the ED. All patients who were suspected to be infected with SARS-CoV-2 and who underwent a typical chest CT imaging were included. Thus, we studied two distinct cohorts: patients with positive RT-PCR (PCR+) and those with negative initial RT-PCR (PCR–). The data were analyzed using Bayesian methods. We included 66 patients in the PCR– group and 198 in the PCR+ group. The baseline characteristics did not differ except in terms of a proportion of lower chronic respiratory disease in the PCR– group. We noted a less severe clinical presentation in the PCR– group (lower respiratory rate, lower oxygen need and mechanical ventilation requirement). Hospital mortality (9.1% vs. 9.6%) did not differ between the two groups. Despite an initially less serious clinical presentation, the mortality of patients infected by SARS-CoV-2 with a negative RT-PCR did not differ from those with positive RT-PCR. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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12 pages, 955 KiB

Open AccessArticle

Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19

by Elisabetta Cocconcelli, Davide Biondini, Chiara Giraudo, Sara Lococo, Nicol Bernardinello, Giulia Fichera, Giulio Barbiero, Gioele Castelli, Silvia Cavinato, Anna Ferrari, Marina Saetta, Annamaria Cattelan, Paolo Spagnolo and Elisabetta Balestro

J. Clin. Med. 2020, 9(9), 2990; https://doi.org/10.3390/jcm9092990 - 16 Sep 2020

Cited by 21 | Viewed by 3417

Abstract

Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic with lung disease representing the main cause of morbidity and mortality. Conventional chest-X ray (CXR) and ultrasound (US) are valuable instruments to assess the extent of lung involvement. We investigated the relationship between [...] Read more.

Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic with lung disease representing the main cause of morbidity and mortality. Conventional chest-X ray (CXR) and ultrasound (US) are valuable instruments to assess the extent of lung involvement. We investigated the relationship between CXR scores on admission and the level of medical care required in patients with COVID-19. Further, we assessed the CXR-US correlation to explore the role of ultrasound in monitoring the course of COVID-19 pneumonia. Clinical features and CXR scores were obtained at admission and correlated with the level of intensity of care required [high- (HIMC) versus low-intensity medical care (LIMC)]. In a subgroup of patients, US findings were correlated with clinical and radiographic parameters. On hospital admission, CXR global score was higher in HIMCs compared to LIMC. Smoking history, pO₂ on admission, cardiovascular and oncologic diseases were independent predictors of HIMC. The US score was positively correlated with FiO₂ while the correlation with CXR global score only trended towards significance. Our study identifies clinical and radiographic features that strongly correlate with higher levels of medical care. The role of lung ultrasound in this setting remains undetermined and needs to be explored in larger prospective studies. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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Review

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16 pages, 2820 KiB

Open AccessReview

Can Adenosine Fight COVID-19 Acute Respiratory Distress Syndrome?

by Carmela Falcone, Massimo Caracciolo, Pierpaolo Correale, Sebastiano Macheda, Eugenio Giuseppe Vadalà, Stefano La Scala, Marco Tescione, Roberta Danieli, Anna Ferrarelli, Maria Grazia Tarsitano, Lorenzo Romano and Antonino De Lorenzo

J. Clin. Med. 2020, 9(9), 3045; https://doi.org/10.3390/jcm9093045 - 21 Sep 2020

Cited by 20 | Viewed by 5315

Abstract

Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has proteins capable of promoting the cytokine [...] Read more.

Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has proteins capable of promoting the cytokine storm, especially in patients with comorbidities, including obesity. Since currently no resolutive therapy for ARDS has been found and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Through its receptors, adenosine is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier, and reduce the damage due to an overactivation of the immune system, such as that occurring in cytokine storms. These features are known in ischemia/reperfusion models and could also be exploited in acute lung injury with hypoxia. Considering these hypotheses, a COVID-19 patient with unresponsive respiratory failure was treated with adenosine for compassionate use. The results showed a rapid improvement of clinical conditions, with negativity of SARS-CoV2 detection. Full article

(This article belongs to the Special Issue COVID-19: Diagnostic Imaging and Beyond - Part I)

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